2HELPS2B Score

Estimate duration of EEG monitoring needed to detect 95% of seizures

The global unit selector only affects unanswered questions
1.Frequency of any periodic or rhythmic pattern of more than 2 Hz except generalized rhythmic delta activity?
2.Independent sporadic epileptiform discharges?
3.Lateralized Periodic Discharges (LPDs), Bilateral Independent Periodic Discharges (BIPDs), or Lateralized Rhythmic Delta Activity (LRDA)?
4.“Plus” features: superimposed rhythmic, fast, or sharp activity only on LRDA, LPDs, or BIPDs?
5.Prior seizure: a history of epilepsy or recent events suspicious for clinical seizures?
6.BIRD: Brief potentially Ictal Rhythmic Discharges?
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1. Frequency of any periodic or rhythmic pattern of more than 2 Hz except generalized rhythmic delta activity?

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About this Calculator

The 2HELPS2B Score was designed to stratify seizure risk in hospital inpatients, and thus improve cost-effectiveness of continuous EEG (cEEG). By doing an initial 1 hour-long EEG and applying the score, patients can be stratified to stop EEG monitoring at that point, or continue to 12 hour or 24-hour cEEG monitoring. To achieve at least a less than 5% risk of undetected seizures, a 2HELPS2B score of 0 only required the 1-hour screening EEG, a 2HELPS2B score of 1 required 12 hours, and a 2HELPS2B score of 2 or greater required 24 hours. The risks of seizures (within 72 hours) for each possible 2HELPS2B score are 5% for a score of 0, 12% for a score of 1, 27% for a score of 2, 50% for a score of 3, 73% for a score of 4, 88%for a score of 5, and greater than 95% for a score of 6 or 7. The score was created in 2017 (Struck et al, 2017), and validated in 2020. It does not apply to patients admitted for elective epilepsy monitoring and post-cardiac arrest patients.


Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ, Gilmore EJ, Vlachy J, Haider HA, Rudin C, Westover MB.

Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients.

JAMA Neurology 2017 December 1, 74 (12): 1419-1424

Struck AF, Fesharaki MT, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, Hernandez C, Kaleem S, Haider HA, Cissé AF, Dhakar MB, Hirsch LJ, Rosenthal ES, Zafar SF, Gaspard N, Westover MB.

Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction.

JAMA Neurology 2020 January 13.

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